The high cost of taking away prisoners’ Medicaid coverage

Local jails and prisons are required to provide prisoners with adequate health care. But the interruption of federal and state programs inmates had been depending on can cause major problems, making it more likely that people will cycle in and out of jail.

Federal rules prohibit states from billing Medicaid for any inmate care unless the covered individual requires a hospital stay of at least 24 hours. They also cut off Social Security and Disability payments and some veterans’ benefits. Medicaid benefits are taken away assoon as a suspect has been booked into jail, whether they’ve been proven guilty or not. If they are convicted and incarcerated, Social Security and VA benefits disappear 30 and 60 days later, respectively.

Corrections departments may contract with an outside company to provide a 60-day in-house treatment program, but most inmates don’t stay long enough to go through with it. And once they leave, treatment ends — at least until they manage to get covered again by Medicaid or other insurance. “On the outside, if they didn’t get their treatment, they’d come right back through the front door again.”

In order to smooth the path back to the outside world and reduce the strain on state budgets, 16 states and Washington, D.C. simply suspend Medicaid benefits and automatically reinstate them upon the inmate’s release, rather than terminating enrollment entirely. That ensures newly released prisonershave coverage immediately, since re-enrolling can take weeks or months. But even in states that automatically reinstate federal benefits, the interruption disrupts lives.

Several bills have been introduced to address these issues in congress, but none have progressed.

“Where we’re seeing current traction is the opioid epidemic,” says Brian Bowden, a health policy expert with the National Association of Counties. “If you were starting folks on treatment before they’re released, then you’re not having that revolving cycle.